An outline concerning the potential use of recombinant human thyrotropin for improving radioiodine therapy of multinodular goiter

Medeiros‐Neto, Geraldo; Marui, Suemi; Knobel, Meyer

doi:10.1007/s12020-008-9077-7

Cited by 34 publications

(25 citation statements)

References 54 publications

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“…This problem may be solved by increasing the radioiodine uptake (RAIU) in such nodular goiters [77]. For this purpose, recent studies using rhTSH in preparation for radioiodine therapy have shown good results [78].…”

Section: Recombinant Human Tsh-stimulated Radioiodine Therapymentioning

confidence: 99%

Etiopathology, clinical features, and treatment of diffuse and multinodular nontoxic goiters

Knobel

2015

J Endocrinol Invest

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Goiter, an enlargement of the thyroid gland, is a common problem in clinical practice associated with iodine deficiency, increase in serum thyroid-stimulating hormone (TSH) level, natural goitrogens, smoking, and lack of selenium and iron. Evidence suggests that heredity also has an important role in the etiology of goiter. The current classification divides goiter into diffuse and nodular, which may be further subdivided into toxic (associated with symptoms of hyperthyroidism, suppressed TSH or both), or nontoxic (associated with a normal TSH level). Nodular thyroid disease with the presence of single or multiple nodules requires evaluation due to the risk of malignancy, toxicity, and local compressive symptoms. Measurement of TSH, accurate imaging with high-resolution ultrasonography or computed tomography, and fine-needle aspiration biopsy are the appropriate methods for evaluation and management of goiter. This review discusses the clinical presentation, diagnostic evaluation, and treatment considerations of nontoxic diffuse and nodular goiters.

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Section: Recombinant Human Tsh-stimulated Radioiodine Therapymentioning

confidence: 99%

Etiopathology, clinical features, and treatment of diffuse and multinodular nontoxic goiters

Knobel

2015

J Endocrinol Invest

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“…Moreover, the irradiation of the body increases. This is why factors which could safely improve the effectiveness of RIT are constantly sought [27]. Thyrotropin is a hormone which has a positive effect on iodine uptake and radiosensitivity of thyroid tissue [28].…”

Section: Discussionmentioning

confidence: 99%

Single, very low dose (0.03 mg) of recombinant human thyrotropin (rhTSH) effectively increases radioiodine uptake in the I-131 treatment of large nontoxic multinodular goiter

et al. 2016

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Single, very low dose (0.03 mg) of recombinant human thyrotropin (rhTSH) effectively increases radioiodine uptake in the I-131 treatment of large nontoxic multinodular goiter The aim of the study was to assess the influence of a single very low dose (0.03 mg) of rhTSH on RAIU and thyroid function in euthyroid (MNG-EU) and subclinical hyperthyroid (MNG-SC) patients with a large multinodular goiter. MATERIAL AND METHODS:40 patients (14 male, 26 female, age 57-80 yr) with large non-toxic MNG over 80 grams and with baseline RAIU < 40% were included into the double-blind randomized study and divided into two groups: rhTSH-group and control group. First group received the single intramuscular injection of 0.03 mg rhTSH and the second received placebo. The RAIU were measured 24 and 48 hours after the rhTSH and then all the patients were administered therapeutic doses of I-131. TSH and free thyroxine levels were measured at 1 st and 2 nd day after the injection of rhTSH and later, at 4 and 8 weeks after the RIT. RESULTS:The mean RAIU increased significantly from 30.44 ± 7.4% to 77.22 ± 8.7% (p < 0.001). There were no statistically significant differences in RAIU between euthyroid (MNG-EU) and subclinically hyperthyroid (MNG-SC) patients. The peak of serum TSH was noticed 24 hours after rhTSH injection and in MNG-EU patients it has remained within normal range, similarly as fT4. In the MNG-SC group the administration of rhTSH resulted in a significant increase in the TSH values after 24 hours, whose mean level slightly exceeded the upper limit of the normal range with normalization at 48 hours. 8 weeks after the RIT, the TSH and fT4 levels did not exceed the normal range and did not differ in a statistically significant way. Conclusions:Even the single very low dose of rhTSH increases the values of RAIU in significant way, in euthyroid and subclinically hyperthyroid patients. The administration of rhTSH is well-tolerated. Neoadjuvant administration of a low dose (0.03 mg) of rhTSH before I-131 seems to be an optimal method of management which may increase the effectiveness of RIT and decrease the exposure of the patients to absorbed doses of ionizing radiation.

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“…rhTSH can at least double thyroid RAIU (12,18,36,37,38), depending on the baseline RAIU, and it determines a more homogeneous distribution of 131 I in MNG (22). During the last decade, and based on the above observations, rhTSH has been evaluated as an adjuvant to 131 I therapy, in an attempt to improve the efficacy of this treatment for MNG (18,39,40). Different rhTSH doses have been utilized: in some studies 0.2 mg or more (41,42,43,44,45,46,47), while in others 0.1 mg or less (11,16,20,24,31,48).…”

Section: Rhtsh and 131 I For Mngmentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: Recombinant human TSH and radioactive iodine therapy in the management of benign multinodular goiter

Graf

2015

European Journal of Endocrinology

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Multinodular goiter (MNG) is a very common thyroid disorder determined by diverse goitrogenic factors, the most important one being iodine deficiency. The clinical presentation of a patient with MNG varies from a completely asymptomatic goiter to a life-threatening disease due to upper airway compression. Patients can develop underlying subclinical or overt hyperthyroidism due to autonomously hyperfunctioning nodules. In the absence of clinical, ultrasonographic, or cytological findings suggestive of malignancy, the best therapeutic approach for a patient with MNG will depend on the size and location of the goiter, the presence and severity of compressive symptoms, and the presence or absence of thyrotoxicosis. There is still no consensus regarding the treatment of atoxic MNGs. Hence, its optimal management remains controversial; possible therapies include levothyroxine (LT 4 ), surgery, and radioactive iodine ( 131 I). Suppressive treatment with LT 4 is discouraged due to the development of sub-clinical or overt hyperthyroidism and to its low efficacy when compared with surgery or 131 I. Total thyroidectomy is effective; however, it is associated with the risk of surgical complications and is often refused by the patient. 131 I therapy is an alternative to thyroid surgery to reduce the size of benign MNGs. Based on the ability of recombinant human TSH (rhTSH) to more than double thyroid 131 I uptake, this compound has been evaluated as an adjuvant to 131 I in the treatment of MNG. Very small doses of rhTSH have been used in patients with MNG and few safety concerns have been observed, but the ideal dose, both effective and safe, is yet to be defined.

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An outline concerning the potential use of recombinant human thyrotropin for improving radioiodine therapy of multinodular goiter

Cited by 34 publications

References 54 publications

Etiopathology, clinical features, and treatment of diffuse and multinodular nontoxic goiters

Etiopathology, clinical features, and treatment of diffuse and multinodular nontoxic goiters

Single, very low dose (0.03 mg) of recombinant human thyrotropin (rhTSH) effectively increases radioiodine uptake in the I-131 treatment of large nontoxic multinodular goiter

THERAPY OF ENDOCRINE DISEASE: Recombinant human TSH and radioactive iodine therapy in the management of benign multinodular goiter

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